The Rotterdam 2003 criteria for PCOS require at least 2 of 3 features: oligo/anovulation, clinical/biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Which polycystic ovarian morphology (PCOM) threshold was updated by the international evidence-based guideline 2018?

• A ≥12 follicles measuring 2–9 mm in either ovary OR ovarian volume >10 mL
• B ≥10 follicles measuring 2–9 mm in both ovaries combined OR ovarian volume >10 mL
• C ≥12 follicles measuring 5–10 mm in each ovary OR ovarian volume >12 mL
• D ≥20 follicles measuring 2–9 mm in either ovary OR ovarian volume >10 mL (using modern transducers ≥8 MHz) ✓

Explanation

The 2018 International Evidence-Based Guideline for PCOS updated the PCOM threshold from the original Rotterdam criterion of ≥12 follicles to ≥20 follicles measuring 2–9 mm per ovary (using transducers ≥8 MHz with appropriate technology) OR ovarian volume >10 mL. This revision accounts for improved ultrasound resolution that detects more follicles in all women; the older threshold over-diagnosed PCOM. If older equipment is used (≤8 MHz), the ≥12 threshold remains.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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